Information on National Focal Point of the Stockholm Convention in the nominating Party: Name: __________________________________________________________ Institution: ______________________________________________________________________ Address: ______________________________________________________________________ Telephone: ____________________________________________________________________ Fax: _________________________________________________________________________ E-mail:________________________________________________________________________ Contact information for nominating Party: Name of contact person: __________________________________________________________ Ministry: ______________________________________________________________________ Address: ______________________________________________________________________ Telephone: ____________________________________________________________________ Fax: _________________________________________________________________________ E-mail:________________________________________________________________________ Date of request for exemption: ____________________________ (day/month/year) Date of expiration of exemption: __________________________ (day/month/year) Identity of substance: Common name: ____________________________________________________________ Chemical name: ____________________________________________________________ CAS number: ______________________________________________________________ Type of chemical (pesticide, industrial chemical, intermediate): _________________________________________________________ Justification for the exemption: ____________________________________________________ ________________________________________________________________________________ Existing national regulatory controls: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Information on existing stockpiles of industrial chemicals and pesticides 1) : Quality: __________________ Quantity (in kg):________________ Quality: __________________ Quantity (in kg):________________ Monitoring and inspection activities: ________________________________________________________________________________ ________________________________________________________________________________
Información sobre el Centro de Coordinación Nacional del Convenio de Estocolmo de la Parte proponente: Nombre: _________________________________________________ _ Institución: _____________________________________________________________________ Dirección: _____________________________________________________________________ Teléfono: ______________________________________________________________________ Fax: __________________________________________________________________________ Correo electrónico:_______________________________________________________________ Información sobre el punto de contacto de la Parte proponente: Nombre de la persona de contacto: __________________________________________________ Ministerio: _____________________________________________________________________ Dirección: _____________________________________________________________________ Teléfono: ______________________________________________________________________ Fax: __________________________________________________________________________ Correo electrónico:_______________________________________________________________ Fecha de solicitud de la exención: _______________________________________ (día/mes/año) Fecha de expiración de la exención: ______________________________________ (día/mes/año) Denominación de la sustancia: Nombre común: ________________________________________________________________ Nombre químico: _______________________________________________________________ Número del CAS: _______________________________________________________________ Tipo de producto químico (plaguicida, producto químico industrial, intermediario): ________________________________________________________ Justificación de la exención: _______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Controles reglamentarios nacionales en vigor: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Información sobre existencias acumuladas de productos químicos industriales y plaguicidas1): Calidad: __________________ Cantidad (en kg.